In August 1993, an outbreak of group C rotavirus-associated gastroenteritis occurred among children attending a day-care centre in Belém, Brazil. Of the 64 children, 21 (33%) became ill. Group C rotavirus was identified in faecal specimens from 8 (38%) children with diarrhoea by electron microscopy (EM) and an enzyme immunoassay (EIA), using antibodies specific to the Cowden strain of porcine group C rotavirus. By polyacrylamide gel electrophoresis (PAGE), a pattern similar to that of group C rotavirus was observed in 5 (62.5%) of the 8 EM- and EIA-positive samples. These 5 faecal samples were confirmed to be positive for group C rotavirus by reverse transcriptase-polymerase chain reaction, using specific VP6 and VP7 primers. This is the first report of an outbreak of diarrhoea in North Brazil associated with group C rotavirus. These findings suggest that group C rotavirus may be an important aetiological agent of diarrhoea in this region, which requires further study.
A hospital-based unmatched case-control study (387 cases and 387 controls) was carried out at the Government Medical College Hospital, Nagpur, India, to devise and validate a risk-scoring system for predicting the development of moderate or severe dehydration in children, aged less than five years, with acute watery diarrhoea. On unconditional multiple logistic regression, 12 risk factors--infancy, minority religion, undernutrition, not washing hands by mother before preparation of food, frequency of stools > 8/day, frequency of vomiting > 2/day, measles in previous 6 months, withdrawal of breast-feeding/other feedings, withdrawal of fluids during diarrhoea, not giving oral rehydration solutions (ORS), home available fluids and both during diarrhoea--were significant. Based on regression coefficients, these factors were ascribed statistical weights of 5, 5, 4, 4, 22, 9, 11, 13, 5, 5, 5, and 7 respectively. The receiver-operating characteristic curve suggested a total score of 48 to be the best cut-off for predicting the development of moderate or severe dehydration. At this cut-off, the sensitivity, specificity, positive predictive value, Cohen's kappa, and overall predictive accuracy were 0.81, 0.81, 0.81, 0.61, and 0.86 respectively. If substantiated by further validation, this system can be used for predicting the development of dehydration at the earlier stage, thereby reducing the mortality associated with life-threatening dehydration.
Acquired Immunodeficiency Syndrome 067 Caeliac Disease 018, 047 Aeromonas 044, 049 Campylobacter 086 Aeromonas hydrophila 048 Campylobacter coli 052, 064 Aeromonas sobria 006, 048 Campylobacter Infections 001, 086 Alanine 069, 073 Campylobacter jejuni 001, 052, 064 Albendazole 088 Carcinoma 070 Amino Acids 073 Cephalosporins 016 Aminobutyric Acids 044 Cereals 045, 059 Aminoglycosides 020 Child Growth 054, 088 Amoebiasis 056 Cholera 090, 100 Anthelmintics 061, 088 Cholera Toxin 025 Anthropometry 093 Cloning, Molecular 100 Antibiotics 060 Clostridium difficile 016, 079, 094 Antibodies 027 Clostridium perfringens 036 Antibodies, Bacterial 012, 014, 039, 044, Colitis, Haemorrhagic 041, 091 083, 085 Colitis, Pseudomembranous 016 Antibodies, Monoclonal 004, 012, 018, 048 Colitis, Ulcerative 092 Antibodies, Protozoan 010, 076 Colony Count, Microbial 002 Antibody Formation 001 Colostrum 024 Antibody Specificity 018 Communicable Diseases 055 Antidiarrhoeals 025 Coronaviridae 073 Antigens, Bacterial 012,030,083 Cross Infection 017, 074, 090 Antigens, Colonization Factor 039 Cryptosporidiosis 024 Ascaris lumbricoides 088 Cryptosporidium 024 Bacteria 029, 094 Culture Media 006, 029 Bacteria, Enteropathogenic 019 Cytotoxins 008, 091 Bacterial Adhesions 022, 026, 039, 083 Dehydration 045, 059 Bacterial Growth 063 Diagnosis, Laboratory 004, 008, 029, 036, Bacterial Infections 060 037, 041, 046, 047, 049, 055, 057, 075, Bacterial Outer Membrane Proteins 064, 083 078, 082 Bacterial Proteins 063 Diarrhoea 004, 019, 025, 028, 032, 033, Bacterial Toxins 006 050, 052, 058, 070, 072, 087 Bacterial Vaccines 030 Diarrhoea, Acute 028, 034, 059, 069, 078, Biopsy 047 096 Blotting, Western 037 Diarrhoea, Chronic 009, 047, 067, 068, Breast Feeding 019, 097 077, 094, 095
The study examines the age-related differences in the density of Escherichia coli heat-stable enterotoxin (STa) receptors in the small intestine of rabbits. The number of STa receptors was found to be 1.7 x 10(12) in 14-day old rabbits compared to 2.4 x 10(9) in 14-week old rabbits per milligram brush-border membrane protein. The STa-induced guanylyl cyclase activity in the intestinal brush-border membranes was found to be stimulated by 6.2 folds over the basal enzyme activity in 14-day old rabbits, whereas in the 14-week old rabbits, it was 4 folds over the basal activity. Moreover, the enzyme activity remained lower in the adult rabbits compared to the younger ones. Autoradiographic analysis of sodium dodecyl sulphate polyacrylamide gel electrophoresis showed two STa-binding proteins of apparent molecular weights of 140 and 38 kDa in the intestinal brush-border membranes of rabbits.
During September 1992-August 1993, stool samples from 157 children with diarrhoea and 157 matched healthy controls were examined for the presence of Aeromonas and other enteropathogens. Aeromonas strains were tested for haemolytic activity, haemagglutination patterns, and antibiotic susceptibility. In total, 62 Aeromonas were isolated, of which 27 (17.2%) were from children with diarrhoea and 35 (22.3%) from healthy controls. Only 23 (14.6%) of the diarrhoeal children and 28 (17.8%) of the healthy controls were positive for Aeromonas; of which, 4 (2.5%) of the diarrhoeal children and 6 (3.8%) of the healthy controls showed multiple species. Aeromonas hydrophila was isolated from 5 (3.2%) children with diarrhoea and from 9 (6.4%) controls, A. veronii by sobria from 8 (5.1%) and 7 (4.5%), A. caviae from 13 (8.3%) and 17 (10.8%), and A. schubertii from 1 (0.6%) and 2 (1.3%) respectively. No significant difference in the haemolytic activity of Aeromonas was found between diarrhoeal and healthy children. However, a significant difference (p<0.002) was observed in mannose-resistant haemagglutination (MRHA) by diarrhoeal isolates of Aeromonas (7/27, 26%) compared to the healthy controls (1/35, 3%). Aeromonas strains were uniformly sensitive to ciprofloxacin, gentamicin, and nalidixic acid. The results of this study suggest that A. caviae strains may be associated with diarrhoea in children and MRHA may be used as one of the virulence markers for distinguishing between Aeromonas isolated from diarrhoeal children and healthy controls or environmental isolates.
To determine the mechanism of enteropathogenicity of the newly described Escherichia species, a total of 50 clinical isolates of Escherichia spp. from diarrhoeal stools were studied. Twelve isolates (24%) were found to be E. vulneris, 6 (12%) E. fergusonii, 2 (4%) E. hermannii, and the rest 30 (60%) were E. coli. Most isolates of the new species were resistant to ampicillin, tetracycline, and co-trimoxazole, but were susceptible to cephalosporins and aminoglycosides. The representative strains of all the new species produced significant fluid accumulation in the rat ileal loops both by live cells and their culture filtrates. E. vulneris, isolated from stools, showed maximum fluid accumulation. Thus, it can be inferred that these species are diarrhoeagenic, but their roles on extra-intestinal infections remain to be determined.
The study was carried out to detect group- and subgroup-specific antigens of bovine rotaviruses. Stool specimens, collected from diarrhoeic calves of the Savar Dairy Farm, Bangladesh, were examined by an enzyme-linked immunosorbent assay, using group- and subgroup-specific monoclonal antibodies. Thirty-three specimens showed specificity for group A rotavirus. While subgrouping, 21 group A-positive specimens showed subgroup I specificity. Twelve specimens did not react with either of the subgroup I- and subgroup II-specific monoclonal antibodies.
Six isolates of Aeromonas eucrenophila--2 from water and 4 from superficial skin ulcer of cat fish--were examined for haemagglutination, serum sensitivity, chitinase production and enterotoxicity, and correlation, if any, between them; only one strain showed haemagglutination and was inhibited by both D-mannose and L-fucose. All the strains showed resistance to normal human serum, but produced chitinase; one of them elaborated inducible chitinase. All these strains caused fluid accumulation only after 1-4 serial passages through rabbit ileal loops, of which one strain that elaborated inducible chitinase caused significantly more (p < 0.005) fluid accumulation. These observations indicate that there is no correlation between enterotoxicity and haemagglutination and/or serum resistance, and these properties did not change after animal passage. However, a correlation could be observed between elaboration of inducible chitinase and enterotoxin production.
This prospective follow-up study was carried out during 1996 to identify the outcome of children rehydrated in the ORT Corner of the Chittagong Medical College Hospital. In total, 269 children, aged less than five years, who attended the ORT Corner, accompanied by their mothers, for treatment of uncomplicated acute watery diarrhoea with 'no signs of dehydration' and 'some dehydration,' were selected for the study. Mothers of the children were interviewed at the ORT Corner, and children were followed-up at home on the 5th post-ORT Corner visit day. The follow-up was completed for 260 cases (96.7%). At follow-up, 227 cases (87.3%) were found to be cured, and 33 cases (12.7%) still had diarrhoea. Of the cured, the mean duration of the episode was 5.84 +/- 2.34 days (95% CI.5.55-6.13 days). All the cases received oral rehydration therapy (ORT) after attending the ORT Corner. Eighty-one cases (31.2%), however, reconsulted the private doctors. Of those who reconsulted, only 3 (3.7%) received WHO-recommended treatment of acute watery diarrhoea, and the rest 78 (96.3%) received medication. The medication prolonged the episode of diarrhoea significantly (6.22 days vs 5.48 days, p < 0.001). None of the cases, who reconsulted the private doctors, revisited the ORT Corner. Treatment by 'ORS only' was mentioned by 64% of the mothers as the reason for non-revisit of the ORT Corner, and 20% of the mothers denied the receipt of any advice about when to revisit the ORT Corner which calls for further strengthening of communication activities of the ORT Corner.
Immunoproliferative small intestinal disease (IPSID) is commonly reported from developing countries with poor socioeconomic conditions, hygiene, and high frequency of gastrointestinal infections and infestations. The disease requires anti-malignant chemotherapy in lymphomatous stage. Reported here is a 20-year old man with IPSID lymphoma who responded to anti-malignant chemotherapy initially, but later deteriorated due to Strongyloides stercoralis infestation, which was treated successfully with mebendazole, Importance of an early recognition and adequate treatment for gastrointestinal infections and infestations before anti-malignant chemotherapy for this disease is highlighted considering the occurrence of this disease in the developing world. The patient developed alternate brown black and white lines in the finger nails after combination chemotherapy, which has not been reported earlier in this disease; the nail changes disappeared 6 months after the withdrawal of doxorubicin suggesting this drug as the cause for such nail changes during anti-malignant combination chemotherapy.
Distribution of human rotavirus G serotype was investigated by enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR) with faecal specimens obtained from children with diarrhoea in Bangladesh. By ELISA, subgroup and G serotype were determined for 59.5% and 28.6% of group A rotavirus-positive specimens respectively. However, of the 120 specimens, the G serotype of which was not determined by ELISA, serotype of the 112 specimens was typed by PCR, In total, G serotype was assigned for 95.2% of all the specimens, showing the highest rate of G4 (41.7%), followed by G1 (23.2%) and G2 (14.9%), Twenty-four specimens showed mixed types, such as G2 with G1, G8 or G9, or G1 with G4, These results indicate that PCR combined with ELISA is highly effective for G serotyping of rotavirus.
Cholera has been recognized as a killer disease since earliest time. Since 1817, six pandemics have swept over the world, and the seventh one is in progress. The disease is caused by infection of the small intestine by Vibrio cholerae O1 and O139 and is characterized by massive acute diarrhoea, vomiting, and dehydration: death occurs in severe, untreated cases. Cholera is a highly contagious disease, and is transmitted primarily by ingestion of faecally-contaminated water by susceptible persons. Besides water, foods have also been recognized as an important vehicle for transmission of cholera. Foods are likely to be faecally contaminated during preparation, particularly by infected food handlers in an unhygienic environment. The physicochemical characteristics of foods that support survival and growth of V. cholerae O1 and O139 include high-moisture content, neutral or an alkaline pH, low temperature, high-organic content, and absence of other competing bacteria. Seafoods, including fish, shellfish, crabs, oysters and clams, have all been incriminated in cholera outbreaks in many countries, including the United States and Australia. Contaminated rice, millet gruel, and vegetables have also been implicated in several outbreaks. Other foods, including fruits (except sour fruits), poultry, meat, and dairy products, have the potential of transmitting cholera. To reduce the risk of food-borne transmission of cholera, it is recommended that foods should be prepared, served, and eaten in an hygienic environment, free from faecal contamination. Proper cooking, storing, and re-heating of foods before eating, and hand-washing with safe water before eating and after defaecation are important safety measures for preventing food-borne transmission of cholera.
Detection of multiple pathogens, particularly a combination of viruses and bacteria, is infrequently documented in outbreaks of gastroenteritis. This paper reports the presence of Norwalk-like virus (NLV) and enterohaemorrhagic verotoxin-producing Escherichia coli in one individual, and NLV and verotoxin-producing Aeromonas sobria in another individual, both part of a large gastroenteritis outbreak. The causes of gastroenteritis in such outbreaks may be more complex than previously thought.
Recent case-control studies in Bangladesh showed a high prevalence of enteropathogenic Escherichia coli (EPEC) strains (identified by DNA probes for virulence genes) associated with childhood diarrhoea. However, the clonal status of these strains is not known. A total of 94 EPEC isolates from 80 children with diarrhoea and 14 healthy matched controls isolated during 1991-1992 and 1993-1994 was characterised by serogrouping, enterobacterial repetitive intergenic consensus sequence PCR, and by a biochemical fingerprinting method (the phene plate or PhP system). Twelve O serogroups were found with O114 (n = 19) and O127 (n = 23) being the dominant serogroups. Most strains of O114 belonged to the same PhP/PCR types. Strains of O127 contained 16 that produced cytolethal distending toxin (CDT) and seven that did not; both were found among patients as well as controls. Results of PCR and PhP typing showed that CDT-positive strains belonged to the same clonal group and were related to one of the two PhP/PCR types of CDT-negative O127 strains. Thirty-one EPEC strains were O non-typable and 21 strains belonged to other less prevalent serogroups. These strains belonged to diverse PhP/PCR types and did not show any similarity to the strains of two major serogroups, O114 and O127. The results suggest that two clonal groups of EPEC strains are predominantly associated with childhood diarrhoea in Bangladesh.
